Taking Pains to Take Care, Both Now and Then

Tuesday

May 25, 2010 at 12:01 AMMay 26, 2010 at 5:15 AM

Examining diets of raw data and health obsessions.

ABIGAIL ZUGER, M.D.

Now that our hospital’s electronic medical record keeps reasonably good track of patients’ blood test and X-ray results, we no longer routinely file the paper copies. And now that I routinely offer these copies to patients, I have learned that the world is divided when it comes to medical self-knowledge.

Half my acquaintances wince and recoil from the papers as if I had offered them a ticking bomb. The other half light up — suddenly it’s Christmas! — and delightedly snatch the sheaf out of my hand. Then they show up at the next visit with the pages underlined and a list of questions.

Presumably, then, half the reading public will scuttle past Thomas Goetz’s new book, “The Decision Tree,” with averted eyes. The others (and you know who you are) will be irresistibly drawn to this new variation on the old genre of self-help health.

Mr. Goetz’s book is brought to us by Rodale, the publishing conglomerate behind Prevention magazine and its not-so-subliminal message that most of the flesh’s ills can be averted with diet, exercise and vigilant attention to the poisons lurking everywhere.

At first Mr. Goetz toes the party line: “In truth, we are constantly making a series of decisions, some unconsciously, some with great intent, that combine to create our health.” His “decision tree” has the usual branches: you address your genetic health risks, critically assess your lifestyle, adopt preventive habits, and emerge in total control, managing your health (in Mr. Goetz’s analogy) as you do your investments.

Well, O.K., I guess, if you don’t count all those health events that clearly result from idle celestial malevolence. Given the recent vagaries of the stock market, control of both health and portfolio may be somewhat more illusory than self-help gurus might like.

But Mr. Goetz brings special talents to this old genre. The executive editor of Wired magazine, he has a fluent command of all the newest Internet-based health tools, and rolls them out one after another for our review. This is where the book becomes interesting.

In a paean to the power of raw data, Mr. Goetz introduces us to gigantic online communities of both the sick and the well, all of them compulsively tracking dozens of markers of wellness or illness, from calories consumed and miles run to milligrams of medication taken. Previous generations may worry about the privacy issues inherent in these mass unburdenings, but the wired generation shrugs: the worry that any health information (like genetic tests) can be dangerous or somehow destructive, he writes, “is a dated and indeed more dangerous notion.”

Mr. Goetz runs through computer-derived algorithms for interpreting some of the diciest biologic indicators (like P.S.A., the substance associated with prostate cancer). He summarizes scientists’ efforts to search through the billions of protein molecules in the human body for less ambiguous early cancer markers.

He winds up at the philosophical boundaries of medicine, where few in the self-help community ever penetrate. What is a good medical decision, exactly? How is it ever possible to apply rigid statistical models to the fuzzy terrain of human well-being? Do we really want to abolish uncertainty from all our medical calculations — for what is uncertainty, after all, but another word for hope?

All in all, Mr. Goetz has compiled a sophisticated and thought- provoking consumer update for those inclined to captain their own medical destinies.

Those who would rather not can always let someone else do it for them. But in one realm they will be forever on their own: namely, what to have for lunch. Even if control is not your thing, you are stuck with choosing your own food. And if you delight in self-empowerment, where better to flex your muscles than by shaping your meals and thence your size, shape and destiny?

Long gone are the days when food was merely fuel, as Susan Yager points out in “The Hundred Year Diet,” her brisk review of the American obsession with diet and weight loss over the last century. It was a British coffin maker, William Banting, who started it all: his 1863 “Letter on Corpulence, Addressed to the Public” described his discovery of a diet free of bread, butter, milk, sugar and beer. (An edition can be found online, at archive.org/details/corpulen00bantletteronrich.) He lost weight, felt great, and the public went crazy for “banting,” but that was only the beginning.

Horace Fletcher masticated his way to slimness, chewing 100 times per minute, not swallowing till each mouthful was liquefied. John Harvey Kellogg of Battle Creek, Mich., eliminated leavened bread, meat and condiments from his sanatorium cuisine, along with coffee and alcohol. (Banting, in contrast, enjoyed his nightly grog.)

Then came the diets relying on special food combinations (pineapple and lamb chops; bananas and skim milk). Then came chemical aids to slimness (dinitrophenol, fucoxanthin and amphetamines). Then came meal replacements (Metrecal and its hundreds of competitors), artificial sweeteners, sodas, high protein regimens, low-fat regimens — the newest invariably reincarnations of those from decades before. Even Dr. Robert C. Atkins was an intellectual heir of a Canadian anthropologist who thrived on an Inuit diet.

There is so much material here that Ms. Yager, a nutrition instructor at New York University, barely has time to catch her breath, let alone dwell on what it all means. For the diet-obsessed among us, her book is a fascinating read; everyone else will probably put it aside and head out for lunch.

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